Abstract
The aim of this pilot study was to evaluate the accuracy of a newly developed dynamic navigation system and to compare the accuracy between flapless and open-flap surgery, and between surgeons. The subjects were patients who were scheduled to receive implants of the same size using the newly developed dynamic navigation system. The study’s procedures included cone beam computed tomography (CBCT) filming with fiducials, virtual planning of implant placement and the use of motion tracking technology for calibration and practical implant placement. The accuracy was evaluated using preoperative (virtual implant) and postoperative (actual implant) CBCT images based on angular, apical, coronal and vertical deviations. The differences of deviations between flapless and open-flap surgery, and between two surgeons, were statistically compared. In total, 66 implants were placed in 39 patients. The median and interquartile range of angular, apical, coronal and vertical deviations were 3.07° (2.52–3.54°), 0.96 mm (0.75–1.42 mm), 0.76 mm (0.57–1.37 mm) and 0.71 mm (0.61–0.88 mm), respectively. These deviations were similar to those found in previous studies. Flapless surgery resulted in a more accurate placement with respect to apical and coronal deviations, and the differences between the two surgeons were limited. The newly developed dynamic navigation system is considered to be eligible for clinical use.
Highlights
Dynamic navigation surgery for dental implant placement has been increasingly used because it has the following advantages: (1) the availability of immediate placement after planning, (2) on-site alteration of implant placement dependent upon the clinical situation and (3) minimally invasive intervention due to real-time visualization [1,2,3,4]
The exclusion criteria included: (1) patients who could not agree the use of this dynamic navigation system and (2) patients with gingival inflammation and dental plaque accumulation
The median and interquartile ranges (IQR) values of implant angular deviation, apical lateral deviation, coronal lateral deviation and vertical deviation were 3.07◦ (2.52–3.54◦), 0.96 mm (0.75–1.42 mm), 0.76 mm (0.57–1.37 mm) and 0.71 mm (0.61–0.88 mm), respectively. (A Shapiro–Wilk test revealed that the deviation data did not show any normal distributions except for vertical deviations, and the present data were described as median and IQR.) To compare the present results with previous studies, the results reported in previous systematic reviews and meta-analyses are shown in Table 2 [24,25,26,27]
Summary
Dynamic navigation surgery for dental implant placement has been increasingly used because it has the following advantages: (1) the availability of immediate placement after planning, (2) on-site alteration of implant placement dependent upon the clinical situation and (3) minimally invasive intervention due to real-time visualization [1,2,3,4]. The workflow of dynamic navigation surgery includes images of cone beam computed tomography (CBCT) with fiducials, virtual planning of implant placement and the use of motion tracking technology for calibration and practical implant placement [4,5,6]. Fiducial markers, attached to the patient’s jaw during CBCT exposure, are registered in software These markers and markers on the surgical handpiece are captured with a tracking camera in order to display the relative position of the jaw and the drill (burr) in CBCT images. These provide guidance for freehand real-time drilling and implant placement. This means that data acquisition and registration are the most crucial procedures for accomplishing the ideal placement as planned
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